"Seek, test, treat and retain" to stem HIV among drug users

Activists and scientists at the International AIDS Conference in Vienna called on governments to stop criminalizing drug users and instead to provide them with addiction and HIV treatment.

"Sooner or later, people have to figure out that we're not going to be able to solve the HIV epidemic if we don't address the needs of injecting drug users [IDUs]," Julio Montaner, president of the International AIDS Society (IAS), said in Vienna.

"If you want an example of that, you have to go to eastern Europe to see where the worst in injection epidemics is now rapidly becoming a mixed epidemic," he added.

Montaner presented evidence from a Canadian study which found that increasing drug users' access to antiretroviral treatment (ARV) could improve health and reduce new infections.

Seek, test, treat and retain

A recent report by the IAS recommends expanding outreach to high-risk, hard-to-reach drug users and encouraging them to test for HIV. Those who test positive would then be referred for care and efforts made to keep them in treatment. According to the report, this "seek, test, treat, and retain" model could be delivered from within the criminal justice system.

Specialists at the conference said few countries with large populations of drug users were using evidence-based methods - such as opioid substitution therapy (OST) - to treat drug addicts and reduce their HIV risk.

The IAS report notes that in Russia, where needle exchange programmes and methadone treatment as a substitute for heroin are illegal, the number of HIV infected people has increased tenfold in the past decade. An estimated 65 percent of HIV infections in Russia are the result of intravenous drug use.

Treating the addiction, treating HIV

"There's tremendous data showing that the risk behaviours are decreased when people have access, not only to the HIV treatment... but [are treated for] their underlying addiction," said Charles O'Brien, a researcher from the University of Pennsylvania. "This helps in many ways - it helps by reducing the risky behaviour - the spread of the infection, but [it] also helps them to adhere to treatment if they're already infected."

There is no successful intervention for HIV that does not include a comprehensive prevention package for IDUs; that is non-negotiable

A recent special edition of the British medical journal, The Lancet, noted that most countries had jailed rather than treated drug users, without success. It noted that incarceration posed a particular risk for injecting drug users (IDUs) as new needles were much harder to come by in prisons.

The Lancet report debunked several myths about HIV and drug users, including non-compliance. Studies show that if counselled properly, drug users on OST stuck with the ARV programme. In addition, studies show that intravenous drug use is not associated with decreased survival rates in patients on ARVs.

Drug users are people too

According to Russian AIDS activist Anya Sarang, more than half a million drug users in Southeast Asia and China are in long-term labour camps where they are given mandatory drug treatment and HIV-positive inmates receive little medical care.

"It seems that drug users are not genuinely considered as humans, and so the concept of human rights doesn't apply," she told the conference. "Drug use has become a label that provides the authorities with justification to act as they see fit, however unthinkable the acts may be."

She urged delegates to sign the Vienna Declaration, which calls for an end to "the war on drug users", and the application of science over ideology to deal with drug use.

Attitude shift

New research and changes in global policy point to a shift in attitudes. Vaccines against cocaine and heroin are undergoing clinical trials and the US President's Emergency Plan for AIDS Relief (PEPFAR) recently changed its policy of excluding needle exchange and OST programmes from funding.

"We are now able to use PEPFAR dollars to respond to active drug-using populations. That will identify, place them in care, retain them in care over time and keep them in a relationship through needle exchange or drug treatment or outreach," Eric Goosby, the US global AIDS coordinator, told IRIN/PlusNews in Vienna.

"We have acknowledged that the natural history of drug addiction is one of repeated episodes of recidivism – we now have a net for them, we won't lose them," he added. "When they are ready to get back into treatment or want to start on methadone treatment, we will have systems that refer them to drug treatment programmes and social service programmes."

There are an estimated five million injecting drug users in 13 PEPFAR-supported countries across eastern Europe, Asia and Africa with drug-driven or emerging HIV epidemics; an estimated 800,000 of these are HIV-positive.

In the Ukraine, six programmes are offering HIV testing, OST, sexual and reproductive health services and legal aid to more than 4,000 women, enabling them to keep their families together, practise healthier behaviour, receive timely medical treatment, and avoid wrongful conviction.

"There is no successful intervention for HIV that does not include a comprehensive prevention package for IDUs," said the IAS's Montaner. "That is non-negotiable."